Alberto Baptista1, Diogo Turiani Hourneaux De Moura2, Pichamol Jirapinyo3, Eduardo Guimarães Hourneaux De Moura4, Andres Gelrud5, Michel Kahaleh6, Alberto Salinas1, Luis Carlos Sabagh7, Andrés Ospina7, Víctor Zambrano Rincones8, Raul Doval9, Jack William Bandel10, Christopher C Thompson3. 1. Hospital das Clínicas Caracas, Unidad de Exploraciones Digestivas, Caracas, Venezuela. 2. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 3. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 4. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 5. Miami Cancer Institute, Miami, Florida, USA. 6. Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA. 7. Hospital Reina Sofia, Bogota, Colombia. 8. Policlínica Metropolitana, Caracas, Venezuela. 9. Centro Médico de Caracas, Caracas, Venezuela. 10. Joe DiMaggio Children's Hospital, Miami, Florida, USA.
Abstract
BACKGROUND: Endoscopy has evolved to become first-line therapy for the treatment of post-bariatric leaks; however, many sessions are often required with variable success rates. Due to these limitations, the use of the cardiac septal defect occluder (CSDO) has recently been reported in this population. METHODS: The study population was a multicenter retrospective series of patients with post-bariatric surgical leaks who underwent treatment with CSDO placement. Data on the type of surgery, previous treatment details, fistula dimensions, success rate, and adverse events were collected. Leaks were grouped according to the International Sleeve Gastrectomy Expert Panel Consensus. Outcomes included technical and clinical success and safety of the CSDO. Regression analysis was performed to determine the predictors of response. RESULTS: Forty-three patients with leaks were included (31 sleeve gastrectomy and 12 Roux-en-Y gastric bypass). They were divided into acute (n = 3), early (n = 5), late (n = 23), and chronic (n = 12). Forty patients had failed previous endoscopic treatment and 3 patients had CSDO as the primary treatment. Median follow-up was 34 weeks. Technical success was achieved in all patients and clinical success in 39 patients (90.7%). All chronic, late, and early leaks were successfully closed, except one undrained late leak. The 5 patients with early leaks had an initial satisfactory response, but within 30 days, drainage recurred. The CSDOs were removed and replaced with larger-diameter devices leading to permanent defect closure. Acute leaks were not successfully closed in all 3 patients. Regression analysis showed that chronicity and previous treatment were associated with fistula closure; success rates for late/chronic leaks versus acute/early leaks were 97.1% and 62.5%, respectively (P = .0023). CONCLUSION: This observational study found that the CSDO had a high efficacy rate in patients with non-acute leaks, with no adverse events. All early, late, and chronic leaks were successfully closed, except for one undrained late leak. However, early leaks required a second placement of a larger CSDO in all cases. These results suggest that the CSDO should be considered for non-acute fistula and that traditional closure methods are likely preferred in the acute and early settings.
BACKGROUND: Endoscopy has evolved to become first-line therapy for the treatment of post-bariatric leaks; however, many sessions are often required with variable success rates. Due to these limitations, the use of the cardiac septal defect occluder (CSDO) has recently been reported in this population. METHODS: The study population was a multicenter retrospective series of patients with post-bariatric surgical leaks who underwent treatment with CSDO placement. Data on the type of surgery, previous treatment details, fistula dimensions, success rate, and adverse events were collected. Leaks were grouped according to the International Sleeve Gastrectomy Expert Panel Consensus. Outcomes included technical and clinical success and safety of the CSDO. Regression analysis was performed to determine the predictors of response. RESULTS: Forty-three patients with leaks were included (31 sleeve gastrectomy and 12 Roux-en-Y gastric bypass). They were divided into acute (n = 3), early (n = 5), late (n = 23), and chronic (n = 12). Forty patients had failed previous endoscopic treatment and 3 patients had CSDO as the primary treatment. Median follow-up was 34 weeks. Technical success was achieved in all patients and clinical success in 39 patients (90.7%). All chronic, late, and early leaks were successfully closed, except one undrained late leak. The 5 patients with early leaks had an initial satisfactory response, but within 30 days, drainage recurred. The CSDOs were removed and replaced with larger-diameter devices leading to permanent defect closure. Acute leaks were not successfully closed in all 3 patients. Regression analysis showed that chronicity and previous treatment were associated with fistula closure; success rates for late/chronic leaks versus acute/early leaks were 97.1% and 62.5%, respectively (P = .0023). CONCLUSION: This observational study found that the CSDO had a high efficacy rate in patients with non-acute leaks, with no adverse events. All early, late, and chronic leaks were successfully closed, except for one undrained late leak. However, early leaks required a second placement of a larger CSDO in all cases. These results suggest that the CSDO should be considered for non-acute fistula and that traditional closure methods are likely preferred in the acute and early settings.
Authors: Marcus Kantowski; Karl Karstens; Pasquale Scognamiglio; Nathaniel Melling; Matthias Reeh; Jakob Izbicki; Thomas Rösch; Michael Tachezy Journal: Sci Rep Date: 2022-07-18 Impact factor: 4.996
Authors: Diogo Turiani Hourneaux de Moura; Bruno Salomão Hirsch; Epifânio Silvino Do Monte Junior; Thomas R McCarty; Flaubert Sena de Medeiros; Christopher C Thompson; Eduardo Guimarães Hourneaux de Moura Journal: VideoGIE Date: 2021-09-04
Authors: Diogo Turiani Hourneaux de Moura; Anna Carolina Batista Dantas; Igor Braga Ribeiro; Thomas R McCarty; Flávio Roberto Takeda; Marco Aurelio Santo; Sergio Carlos Nahas; Eduardo Guimarães Hourneaux de Moura Journal: World J Gastrointest Surg Date: 2022-02-27
Authors: Hytham K S Hamid; Sameh H Emile; Alan A Saber; Mürşit Dincer; Diogo T H de Moura; Lennard P L Gilissen; Majid A Almadi; Mauro Montuori; Michel Vix; Luis G S Perisse; Nicolás Quezada; Fabio Garofalo; Radu Pescarus Journal: Surg Endosc Date: 2020-11-06 Impact factor: 4.584